Ghetti Claudio B, Rooney Alexandra S, de Cos Víctor, Henry Owen S, Sykes Alicia G, Krzyzaniak Andrea, Bansal Vishal, Sise Michael, Bickler Stephen W, Keller Benjamin, Ignacio Romeo C
University of California, San Diego School of Medicine, San Diego, CA, United States.
Rady Children's Hospital San Diego, San Diego, CA, United States.
J Pediatr Surg. 2023 Jan;58(1):125-129. doi: 10.1016/j.jpedsurg.2022.09.031. Epub 2022 Sep 27.
To identify patient factors associated with improper restraint usage and worse trauma outcomes for pediatric patients involved in motor vehicle collisions (MVCs).
Retrospective study performed at a Level I pediatric trauma center for patients (≤18 yr) evaluated after MVC between 2008 and 2018. The Area Deprivation Index (ADI) was used to measure neighborhood socioeconomic disadvantage (NSD) levels based on the patient's home address. Trauma registry data was correlated to ADI and used to analyze appropriate restraint usage by NSD. Proper restraint practices were defined based on national guidelines and state laws. Demographics and clinical outcomes were also analyzed. Chi-square analysis with Bonferroni corrections was used to assess the association of ADI, race, and ethnicity with proper restraint usage.
Among 1152 patients included, approximately 50% were male, the median age was 7 years [IQR 4-10], and 53% were of Hispanic ethnicity. Hispanic patients comprised 73% of children in ADI quintile 5 (greatest NSD), yet only 26% of children in ADI quintile 1 (least NSD). No differences were observed across clinical data and outcomes. Hispanic children <8 yr were significantly less likely to be in a car seat/booster seat compared to non-Hispanic children (OR 0.69, 95% CI 0.50-0.95, p = 0.025). Furthermore, those with greatest NSD (ADI quintile 5) had the largest proportion of unrestrained patients (21%, see Fig. 1).
Hispanic children, especially those who require infant or booster seats (<8 yr), and children living in areas with greater neighborhood socioeconomic disadvantage demonstrated poorer restraint practices. ADI can successfully identify high-risk groups for targeted injury prevention programs and improved compliance in the most vulnerable neighborhoods.
Retrospective Study.
确定与机动车碰撞（MVC）中涉及的儿科患者约束使用不当及更差创伤结局相关的患者因素。
在一家一级儿科创伤中心对2008年至2018年间因MVC接受评估的患者（≤18岁）进行回顾性研究。使用地区贫困指数（ADI）根据患者家庭住址测量邻里社会经济劣势（NSD）水平。创伤登记数据与ADI相关联，并用于分析按NSD划分的适当约束使用情况。根据国家指南和州法律定义适当的约束措施。还分析了人口统计学和临床结局。采用经Bonferroni校正的卡方分析评估ADI、种族和民族与适当约束使用之间的关联。
在纳入的1152例患者中，约50%为男性，中位年龄为7岁[四分位间距4 - 10]，53%为西班牙裔。西班牙裔患者占ADI五分位数5（NSD最大）中儿童的73%，但仅占ADI五分位数1（NSD最小）中儿童的26%。在临床数据和结局方面未观察到差异。与非西班牙裔儿童相比，<8岁的西班牙裔儿童使用汽车座椅/增高座椅的可能性显著更低（比值比0.69，95%置信区间0.50 - 0.95，p = 0.025）。此外，NSD最大（ADI五分位数5）的患者中未受约束患者的比例最高（21%，见图1）。
西班牙裔儿童，尤其是那些需要婴儿或增高座椅（<8岁）的儿童，以及生活在邻里社会经济劣势更大地区的儿童，约束措施执行情况较差。ADI可成功识别高危群体，用于针对性的伤害预防项目，并提高最脆弱社区的依从性。
回顾性研究。
